Patient Reference Guide. Osteoarthritis. Care for Adults With Osteoarthritis of the Knee, Hip, or Hand

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Darlene Nash
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1 Patient Reference Guide Osteoarthritis Care for Adults With Osteoarthritis of the Knee, Hip, or Hand

2 Quality standards outline what high-quality care looks like. They focus on conditions or topics where there are large variations in how care is delivered, or where there are gaps between the care provided in Ontario and the care patients should receive. This guide addresses variations and gaps in care in Ontario that need attention when it comes to managing osteoarthritis of the knee, hip, or hand. It is based on the best available evidence and was created in partnership with people with osteoarthritis, their family and caregivers, and health care professionals. The quality standard, available on our website, contains more information. You can find it at hqontario.ca. In this guide, we use the following term: Health care professional: the many types of people who may be part of your health care team, including: Primary care providers, such as a family doctor or nurse practitioner Doctors who focus on pain management or sport and exercise medicine A chiropractor, dietitian, nurse, occupational therapist, pharmacist, or physiotherapist A psychologist, counsellor, or other health care professional who can help you manage your symptoms (such as pain, poor sleep, anxiety and mood, or weight) Doctors who are specialists, such as an orthopaedic surgeon, physiatrist, plastic surgeon, or rheumatologist

3 This guide is for adults with osteoarthritis of the knee, hip, or hand. It can help you know what to ask for when receiving treatment and to ensure you receive the highest-quality care. Osteoarthritis is a condition that affects the joints (the places where bones meet so you can bend and move), causing pain, swelling, and/or stiffness. Knees, hip, and hands are the joints most commonly affected by this type of arthritis. Osteoarthritis tends to get worse with time and can make it hard to do your normal activities. But there are ways to manage your symptoms and improve your quality of life. The people on your health care team want to help you feel confident to manage your symptoms and live the best life you can. The more they know about you and your goals, the better they can help create a plan that meets your needs. If you or someone you care about is looking to manage their osteoarthritis... You can use this guide to work with your health care professionals to make a plan that works for you, including access to culturally appropriate care. We encourage you to use this guide to ask informed questions and to learn more about what types of care can help. This guide includes information on: Diagnosis, assessment, and care plans Learning to manage your osteoarthritis through exercises, daily physical activity, weight management, and other strategies Pain medication Referrals for other advice, treatment, or surgery Care plans can be very different for each person, so it is important to work closely with your health care professionals to create a care plan that works for you. Here are some things to consider. Osteoarthritis Care for Adults With Osteoarthritis of the Knee, Hip, or Hand 1

4 How Will I Know if I Have Osteoarthritis? You should see a health care professional if you have persistent pain, aching, and/or stiffness in your knee, hip, or hand when you move it. This does not apply if you have had a recent injury involving that joint or the area around it. Getting a diagnosis early is important so that you can manage symptoms and maintain your quality of life. The symptoms of osteoarthritis tend to get worse with time, so it s best to start therapies early. To diagnose your condition, your health care professional will examine you and ask about your symptoms. You will not need an x-ray or a magnetic resonance imaging (MRI) scan to make a diagnosis if you are 40 or older and have symptoms typical of osteoarthritis. This is because osteoarthritis is more common in this age group, and an x-ray or MRI will not explain your symptoms or help in making a diagnosis. Initial decisions about your treatment can usually be based on the examination and how your symptoms are affecting your life. What s a Care Plan? Your health care professionals should do a comprehensive assessment that covers your overall health. They should talk with you about how your osteoarthritis affects your energy, mood, sleep, work, hobbies, family, and social life. They should use this information to develop a care plan with you that is started within 3 months of your diagnosis. Your care plan should outline how you and your health care professionals will work together to improve your symptoms and your ability to keep doing your usual activities. Together, you should review this plan at every visit and change it as needed. 2 Osteoarthritis Care for Adults With Osteoarthritis of the Knee, Hip, or Hand

5 How Can I Manage My Osteoarthritis? Education Your health care professionals should help you learn about your osteoarthritis and how to manage it. They may provide this information directly or refer you to education programs in your community. They should provide this information when you are first diagnosed and again as your needs change. Each person will need different types of information, but there are key things everyone with osteoarthritis needs to know: Your health care professionals should talk with you about the importance of being physically active, doing specific exercises, and managing your weight. These things can help reduce your pain, improve other symptoms (such as poor sleep and mood changes), and maintain your ability to function Your health care professionals should show you how to protect your joints and prevent injury while being physically active (for example, by taking short breaks to allow the joint to rest) Your Self-Management Plan Your health care professionals should work with you to create a self-management plan. This is the part of your care plan that focuses on your role in your care. Your self-management plan is where you can set goals for living with osteoarthritis, create action plans, solve problems that arise, and chart your progress. Your plan should include information about how to access local services, such as exercise classes, weight-management programs, and support groups. Your plan will also need to consider any other medical conditions you have that may impact your goals and abilities. Depending on your needs, your plan might also include information about aids and devices such as suitable shoes, leg braces, orthotics, and hand grips. These things can help you stay active and function well. Osteoarthritis Care for Adults With Osteoarthritis of the Knee, Hip, or Hand 3

6 Therapeutic Exercise If you have osteoarthritis in your hip or knee, doing specific types of exercises can reduce your pain and improve your ability to move. Your health care professionals should provide you with a therapeutic exercise program designed for your needs. To make sure you benefit from these exercises, your health care professionals should show you how to do them properly and safely. They should show you how to gradually do more challenging exercises and to increase the amount you can do. Therapeutic exercise is a planned program of exercises to strengthen your muscles and train them to move in ways that reduce the load on your joints. If you have hip or knee osteoarthritis, your exercise program should target the muscles in your legs, abdomen, and back. It should also include exercises to improve your heart and lung fitness. This will give you more energy to do your activities. 4 Osteoarthritis Care for Adults With Osteoarthritis of the Knee, Hip, or Hand

7 Physical Activity In addition to your therapeutic exercise program, your health care professionals should encourage you to be physically active every day. Even a small amount of activity is good. Regular physical activity can greatly reduce the pain, aching, and stiffness related to your osteoarthritis and improve your overall health. Walking, biking, swimming, rowing, aqua-fit, and walking in a pool are activities that are gentler on the joints. Yoga and Tai Chi are also good but may need to be modified for you. Brisk walking, biking, household chores, dancing, and yardwork are examples of moderate activity. Examples of vigorous activity are faster-paced walking, biking uphill, and swimming laps. If you feel pain when you are active, it does not mean you are damaging your joints. If an activity does make your symptoms worse, your health care professionals should show you how to modify it, or recommend other activities. You should aim to do as much physical activity as you can tolerate. A good target is at least 150 minutes of moderate to vigorous activity each week. Being active in bouts of 10 minutes or more will give you health benefits. If you find the target of 150 minutes each week is too hard, you can start small and gradually increase the amount of physical activity you do each day. Your health care professionals should work with you on a plan to reach your goals, or refer you to community programs that can help. Weight Management Being overweight can make joint pain and mobility worse. Losing weight can improve your symptoms. If you have osteoarthritis and are overweight, your health care professionals should offer you help to lose at least 5% to 10% of your body weight. If you are at a healthy weight, they should encourage you to maintain it. If you need help, your primary care provider should refer you to a weight-management program or dietitian. They can support you with information and advice on things like how eating and exercise work together to affect your weight and how to stay motivated and reach your weight-loss goals. Osteoarthritis Care for Adults With Osteoarthritis of the Knee, Hip, or Hand 5

8 Who Will Be Involved in My Care? Your primary care provider may suggest you see another health care professional with additional skills in helping people manage their osteoarthritis symptoms, to see if you could benefit from further assessment or treatment. Ask your primary care provider who will contact you about any upcoming assessment or treatment. Health care professionals you re referred to should send notes about your progress to your primary care provider. Your primary care provider should share this information with you at your next appointment. Your overall care will remain the responsibility of your primary care provider so that you can avoid unnecessary assessments, investigations, or treatments. Will I Need Pain Medication? If things like exercise and weight management are not working well enough to control your symptoms, your primary care provider should offer you options for pain-relieving medication. If you decide to use pain medication, it is important to continue using other nondrug treatments as well. One does not replace the other. Your primary care provider should work with you to make a plan to review your medication use after a certain time. However, if you experience any side effects from the medication, tell your primary care provider right away. Your primary care provider should first offer you a cream to rub over the joint. If this doesn t work for you, they may recommend over-thecounter pills (such as low-dose analgesics and/or nonsteroidal anti-inflammatory drugs), prescription pills, or an injection into the joint. Your primary care provider should not offer you an opioid medication as the first or routine treatment for your osteoarthritis pain. These drugs have serious risks including addiction, overdose, and death. For more information, please see our patient reference guide Opioid Prescribing for Chronic Pain. 6 Osteoarthritis Care for Adults With Osteoarthritis of the Knee, Hip, or Hand

9 Will I Need Surgery? If you have tried to manage your symptoms using the treatments described in this guide, and your osteoarthritis symptoms are making it difficult for you to manage day to day, your health care professionals may suggest that you be referred for an assessment to see if you could benefit from surgery to realign or replace your painful joint. Joint replacement can greatly reduce pain and improve function for people severely affected by osteoarthritis. If you have knee osteoarthritis, your surgeon should not offer you a treatment called arthroscopy. (In this procedure, a tube-like device is inserted into a joint to examine and treat it.) Arthroscopy does not reduce pain or improve function in people with knee osteoarthritis, so it should not be used. The benefits do not outweigh the risks. You and your care providers should be aware that some treatments and programs described in this guide are not funded publicly, and you may need to pay for these services directly or through private insurance. We know that osteoarthritis is painful and can affect your life in many ways. Your health care professionals will work with you to help improve your quality of life and help you meet your goals. Everybody is different, and some options may not apply in your situation. If you have questions about your care, it is important to speak with your health care professionals. Osteoarthritis Care for Adults With Osteoarthritis of the Knee, Hip, or Hand 7

10 Looking for More Information? Please contact us at or if you have any questions or feedback about this patient reference guide. The quality standard, available on our website, contains more information. You can find it at hqontario.ca. About Health Quality Ontario Health Quality Ontario is the provincial leader on the quality of health care. We help nurses, doctors and others working hard on the frontlines be more effective in what they do by providing objective advice and by supporting them and government in improving health care for the people of Ontario. Our focus is making health care more effective, efficient and affordable which we do through a legislative mandate of: Reporting to the public, organizations and health care providers on how the health system is performing, Finding the best evidence of what works, and Translating this evidence into concrete standards, recommendations and tools that health care providers can easily put into practice to make improvements. For more information about Health Quality Ontario and our quality standards, visit hqontario.ca. ISBN (Print) ISBN (PDF) Queen s Printer for Ontario, 2018

Opioid Prescribing for Acute Pain

Patient Reference Guide Opioid Prescribing for Acute Pain Care for People 15 Years of Age and Older Quality standards outline what high-quality care looks like. They focus on conditions or topics where